The genesis of Frailty
For the past six months I have been writing about all the degenerative diseases which assail us as the years go by. These are the Non-Communicable Diseases (NCDs) which wear us down and, if they don’t kill us by then, lead to FRAILTY – of old age.
Frailty in old age is a huge and growing problem and the role of exercise in the prevention and treatment of frailty is one of the most important things I have to tell you about. Frailty is a threat which affects all of us and decides the pattern not only of our futures but also of the social and financial health of the nation. I will spend several Blogs on this subject.
What is Frailty?
Frailty has been defined as a “clinically recognisable state of increased vulnerability resulting from aging-associated decline in reserve and function across multiple physiologic systems such that the ability to cope with every day or acute stressors is compromised”! In brief, old and feeble. Frailty is the condition of general weakness and debility which is often seen as an inevitable consequence of the ageing process. Some of the essential features include low grip strength, low energy, slowed walking speed, low physical activity, and/or unintentional weight loss.
How is it diagnosed?
There are lots of tests for frailty – such as usual walking speed, grip strength and get-up-and-go tests.
Here is a test for frailty: Sit in an upright chair. Start your stopwatch, get up and walk 3 yards, turn round, return to your chair and sit down. A time of less than 10 seconds is normal, between 10 and 20 seconds is an indicator of encroaching frailty and more than 20 seconds is characteristic of frailty.
Slightly more complicated is the five repetition chair rise test with an increased risk of falling for those who take more than a minute to achieve the five up and downs. Walking speed is also an indicator of frailty – being capable of more than 1 3/4 mph rules out frailty but below 11/2 mph, the slower you are the frailer you are likely to be.
What cause frailty?
Frailty is closely allied to loss of muscle tissue. As we age we all lose muscle mass and strength, a condition called sarcopenia. A degree of age-related sarcopenia is unavoidable but the rate at which we lose muscle is largely dependent on how much exercise we take. By the seventh and eighth decade of life, maximal voluntary muscle contractile strength is decreased, on average, by 20 to 40% for both men and women. Most of this loss of strength is caused by decreased muscle mass. The resulting progressive loss of neuromuscular function leads to increasing disability and loss of independence. The prevalence of sarcopenia increases with each 5-year age group from about 15% among the 65 to 70 year olds to as much as 50% in the over 85s and probably becoming increasingly common thereafter. It accelerates with the passing of the years. As the age of the population grows so will the numbers with sarcopenia.
Why is it so important?
“The accelerated loss of aerobic capacity with advancing age has important clinical ramifications. The ability of older persons to function independently in the community depends largely on maintenance of sufficient aerobic capacity and muscle strength to perform daily activities. The perceived degree of effort and breathlessness of a given activity is determined by its oxygen cost relative to a person’s peak VO2. Tasks perceived as requiring substantial effort in deconditioned individuals tend to be avoided, setting off a vicious circle of further reduction in aerobic capacity, causing further avoidance of physical activity and further loss of muscle mass and strength.”
This is what frailty is all about – and it is not an inevitable consequence of ageing but, at least in part, a lifestyle choice.
Don’t kill Granny…..send her to the gym
The importance and the dangerous consequences of frailty have been highlighted by the pandemic. We have been made very aware of the legions of elderly people incarcerated in care homes. We are exhorted to protect them, though with increasing numbers of victims and decreasing numbers of carers this is becoming an impossible task.
No-one is talking about prevention. Maybe Granny does not need to be frail.
To read more about Granny go to: